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r <br /> San Joaquin County <br /> Environmental Health Departmen (° eCEI111� -�, SITE <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202 U v F�TIGATION <br /> (209)468-3449 Fax: (209)468-3433 Web: www.sjgov.org <br /> � 5 2008 UNIT IV <br /> Well Permit Application <br /> HEALTH <br /> NON-REFUNDABLE PERMIT EXPIRES II YEAR FROM DATE ISSW M!T�ENT/,,,,_ <br /> SFRVtGFS <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is made in compliance with San <br /> Joaquin County Development Title,Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br /> Assessors <br /> WELL Location 26090 N. Thornton Rd. Cross Street Mokulumne City Thornton Zip CA Parcel# 001-150-48 <br /> PROPERTY <br /> Owner SARBER RONALD J JR & BONNIE J Address 10411 SMALL RD City MANTECA Zip 95336 Phone# (209) 932-0606 <br /> C-57 Contractor Gregg Drilling Address 950 Howe Ave City MartinezZip94553 Lic#485165 Phone# 925-313-5800 <br /> Consultant/Sub Cntr Advanced GeoEnvironmental Address 837 Shaw Rd. City Stockton LIC# 680227 Phone# 209-467-1006 <br /> GIS Coordinates:X 'Y Township Range Section <br /> WORK TO BE PERFORMED: <br /> 8 NEW WELL/BORING (CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER*) p DESTRUCTION (choose type below) <br /> a SOIL BORING# a OVER-BORE. DIAMETER <br /> { WELL# vw-1,VW-2,vw-3,AW-1 a PRESSURE GROUT <br /> u*Other GROUT SPECIFICATIONS <br /> COMMENTS: <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> a MONITORING laHOLLOW STEM DIA.OF BOREHOLE 8-10"o MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA:2-4 <br /> a EXTRACTION a AIR HAMMER/DRIVEN CASING THICKNESS SCHD 40 TYPE OF CASING: U STEEL (f PVC D OTHER: <br /> ff VAPOR a MUD ROTARY DEPTH OF GROUT SEAL 8-17' TREMIE TYPE TO BE USED: ff AUGERS a HOSE <br /> a AIR SPARGE/OZONE p PUSH POINT(GP or CPT)GROUT SEAL PUMPED: a Yes p No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br /> a SOIL BORING a HAND AUGER GROUT SPECIFICATIONS Portland Type II <br /> 0 OTHER: p OTHER APPROX.BORING DEPTH 13-231 itBOLTED TRAFFIC BOX or 0 STOVE PIPE <br /> CONDUCTOR CASING PROPOSED NA (if YES,list specifications in comment section) <br /> COMMENTS: VW wells are soil-vapor extraction wells (411diameter,81grout,131total depth). AW well is an air sparge well <br /> (2--diameter, 17-grout, 23-total depth) <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, Ru .and Regulations, and all applicable California State Laws. <br /> Signe Title/Company Staff Geologist/Advanced GeoEnvironmental <br /> Print Name Lauren Cardinalli Date o4/22/ns <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADDRESS: L Ak,4 <br /> WORK PLAN DATED: 3 TOON <br /> i <br /> Application Accepted Date Issued 1�>/d� Area 7F7 <br /> Grout Inspection By Date 5 o Final Inspection By Date <br /> Destruction Inspection By Date <br /> COMMENTS/CONDITIONS:C UA Q C- U <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODES FEE INFO AMOUNT REMITTED CHECK# REC'D BY DATE PERMIT/SERVICE REQUEST# INVOICE <br /> �R nom} ,�i r� ✓: t'// �) SR# <br /> C-57_ WC=WAIVER_ C-57 Letter of Authorization to sign permit Encroachment doc_ <br /> EHD 29-02-001 <br /> 6/22/04 ' <br /> 6S-sr <br />